RESULTS OF BLINDED RESCREENING OF PAPANICOLAOU SMEARS VERSUS BIASED RETROSPECTIVE REVIEW

Review of Papanicolaou smear cases that are the focus of litigation ty pically takes place in a biased setting with foreknowledge of an adver se patient outcome (outcome bias) or litigation and with more time all otted for slide review than is available in normal screening situation s. Factors that normally mitigate against overly aggressive slide inte rpretation, such as concern about false-positive diagnoses and possibl e unnecessary surgical procedures and expense, are absent. This result s in a tendency toward overly aggressive interpretation of questionabl e or uncertain cytologic abnormalities. These factors can be minimized by a variety of blinded slide review formats with the goal of simulat ing normal, on-the-job, prospective screening as in actual practice. D espite some limitations, blinded rescreening can provide valuable insi ght into the relative degree of difficulty involved in interpreting sp ecific slides. The difficulty of a case in question is arguably the se cond most important factor, after assessment of overall laboratory per formance, in determining whether a reasonable standard of practice has been followed.